BMC Pregnancy and Childbirth最新文献

Background: Despite global declines in the maternal mortality ratio (MMR), significant disparities persist across regions and socioeconomic strata. This study aims to examine spatiotemporal trends in MMR from 1990 to 2021, with a specific breakdown by age, socio-demographic index (SDI) and cause of death, to better clarify the underlying determinants of these patterns.

Methods: Utilizing data from the Global Burden of Disease (GBD) Study 2021, we examined MMR trends attributable to ten distinct causes across 204 countries and territories from 1990 to 2021. Analyses were stratified by the SDI, and temporal patterns in age-specific and regional MMR distribution were evaluated.

Results: The global MMR declined from 260.02 per 100,000 live births in 1990 to 147.77 per 100,000 live births in 2021. High SDI regions plateaued at 17.76 deaths per 100,000, whereas low-SDI regions continued to experience a significantly higher burdened (286.49 deaths per 100,000). Age-specific mortality exhibited a U-shaped curve, with peaks among individuals aged 10-19 years and 35-49 age groups. Maternal hemorrhage and hypertensive disorders emerged as the predominant global causes of maternal deaths, with regional variations: abortion-related complications prevailed in high-SDI regions, while sub-Saharan Africa bore a disproportionate burden from HIV/AIDS and other indirect causes disproportionately affected sub-Saharan Africa.

Conclusions: There is a persistent global disparity in MMR despite overall declines. Achieving the Sustainable Development Goals (SDGs) requires addressing inequities through strengthened health data systems, expanded maternal healthcare coverage, improved access to contraception and safe abortion, and enhanced health system monitoring. Evaluating SDI is crucial for tailored strategies to optimize health systems and improve maternal health outcomes worldwide.

Background: Fetal intracranial haemorrhage (ICH) is a rare antenatal complication that increases perinatal morbidity and mortality and may cause neurodevelopmental delay in surviving babies. Even though the majority of cases are idiopathic, there are many maternal and fetal factors predisposing to ICH. Low-dose aspirin (LDA) has a proven efficacy in secondary preeclampsia; however, with a daily dosage of > 100 mg, its safety is not well established and sporadic cases of fetal hemorrhagic complications have been reported. As fetal ICH has prognostic implications for the current and potentially for future pregnancies, in utero diagnosis is of utmost importance.

Case presentation: A 34-year-old primigravida was diagnosed with fetal subdural hematoma (SDH) on her routine third-trimester ultrasound (USG). There were no predisposing factors except that the patient was on LDA from the 12th week of gestation. The LDA was stopped at the 32nd week of gestation, and on serial USG, the SDH reduced in size. She delivered a healthy baby who was followed till 18 months of age and showed normal neurodevelopment.

Conclusions: As the number of reported cases of fetal ICH is limited, with even rarer SDH, meaningful etiological and prognostic criteria cannot be inferred, and parental counselling is challenging. The present case underscores the cautious patient selection and regular fetal monitoring in aspirin-treated pregnancies.

Background: Stillbirth, defined as the death of a fetus at or after 22 weeks of gestation, remains a neglected public health issue, with approximately 2 million stillbirths occurring annually. Pakistan ranks among the top three countries with the highest number of stillbirths, yet progress in reducing stillbirth rates remains slower than regional and global averages. Despite the substantial burden, there is a lack of evidence on the prevalence, geographic variation, and predictors of stillbirths in Pakistan, particularly from marginalized settings.

Methods: We conducted a longitudinal cohort study in 12 selected public and private birthing facilities located in Karachi, Sindh, Pakistan between February 9, 2021, and January 1, 2022. We enrolled pregnant women visiting the selected birthing sites during antenatal care visits and those directly visiting for deliveries. We used the World Health Organization (WHO) standard definition of stillbirth occurring at a gestational age of ≥22 weeks. We analyzed stillbirth rates across birthing sites, geographic location, and gestational age, and used firth logistic regression to identify risk factors for stillbirths.

Results: Of the pregnant women enrolled (n = 21,523), 63.5% (13,668/21,523) with a gestational age ≥ 22 weeks delivered their babies at the study birthing facilities. The overall weighted stillbirth rate was 12.0 per 1,000 births across all sites. The prevalence varied substantially across sites, geographic location, gestational age, and facility type (public or private). Multivariable logistic regression showed a significant association between polio-endemic super high-risk union councils (AHR: 3.53; CI: 1.84-6.75), preterm delivery (AHR: 3.97; CI: 1.42-11.16), unvaccinated for Tetanus Toxoid (TT) vaccine during pregnancy (AHR: 5.29; CI: 2.61-10.74), and having received <8 ANC visits (AHR: 2.40; CI: 1.04-5.53) with stillbirth outcomes.

Conclusion: Our study found significant variation in stillbirth prevalence across birthing facilities and geographic locations, with notably higher stillbirth rates in polio-endemic regions. These findings highlight the need for integrated approaches that combine polio eradication efforts with enhanced maternal healthcare services including maternal immunizations to maximize efficiency and impact. Additionally, efforts are needed to ensure high-quality antenatal care services and efficient management of medical conditions and prematurity during pregnancy.

Background: Exclusive breastfeeding is recommended for at least the first six months of life, however in South Africa only 32% of mothers are exclusively breastfeeding to six months and discontinuation happens early. Nurses are a key resource for promoting breastfeeding self-efficacy and thus exclusivity, yet mothers often report nurses to have poor attitudes, which deter health seeking behaviour. This study aimed to infer whether perceived support from nurses immediately postpartum was causally related to breastfeeding exclusivity, and specifically whether this effect was mediated via breastfeeding self-efficacy.

Methods: This cross-sectional study recruited mothers from two community clinics in Soweto and collected data on breastfeeding practices, breastfeeding self-efficacy, and mothers' perceived support received from nurses within the first few days following delivery. To estimate the causal effect, G-computation for mediation analysis with Monte Carlo simulation was used. In all cases, 1000 bootstrapped samples were created to tighten the estimates, and bias corrected 95% confidence intervals were presented.

Results: Data from 169 participants were included in the analysis. Most participants (55%) scored 70/70 on the breastfeeding self-efficacy scale, and only 14% scored below 56/70 (lowest quartile). Less than half of the women found the nurses helpful 'always'. Most data were collected within 4 days of birth (IQR: 3-7 days), with only 10% being collected after 12 days. While nearly 90% of women were breastfeeding at this time, only 78% were exclusively breastfeeding. The results from the mediation analysis show that there was a total causal effect of finding nurses helpful on breastfeeding exclusivity, whereby finding nurses 'always' helpful resulted in a 14% greater likelihood of exclusively breastfeeding (SE = 0.06, p = 0.03, BC 95% = 0.00 to 0.24). However, this effect was not mediated via breastfeeding self-efficacy (proportion mediated = 7%; NIE = 0.01, BC 95%: -0.00 to 0.05).

Conclusions: There is evidently a need for proper training for healthcare workers in supporting mothers and providing antenatal education and anticipatory guidance around breastfeeding given the impactful role they have on breastfeeding decision making. We recommend that interventions to promote breastfeeding exclusivity need to happen prior to delivery, or immediately upon delivery. Furthermore, all clinics need to enforce the BFHI immediately to provide mothers with a chance at exclusivity.

Background: Indomethacin is one of the most effective and widely used tocolytic agents for treating threatened preterm labor and prolonging pregnancy. Nonetheless, data on its fetal effects, particularly regarding cardiac functions, remain limited. The primary aim of this study was to evaluate the effects of indomethacin treatment on fetal cardiac structures, the modified myocardial performance index (Mod-MPI), and hemodynamic parameters to establish evidence-based monitoring recommendations in cases of threatened preterm labor.

Methods: In this prospective study of 114 pregnant women, 57 cases diagnosed with threatened preterm birth received indomethacin tocolytic therapy, while 57 controls had uneventful pregnancies. Demographic characteristics, perinatal outcomes, Doppler measurements, cardiac structural measurements, Mod-MPI, and tricuspid regurgitation were compared between groups.

Results: Doppler analysis revealed no significant differences except for umbilical artery pulsatility index, which was elevated in the indomethacin group (0.941 ± 0.160 vs. 0.869 ± 0.171, p = 0.023) due to vasoconstrictive effects from prostaglandin synthesis inhibition. Isovolumetric contraction and relaxation times were lower in the indomethacin group (42.3 ± 0.5 vs. 47.2 ± 2.7, p = 0.020; 49.3 ± 1.9 vs. 48.2 ± 1.8, p = 0.030). However, Mod-MPI did not differ significantly between the groups (0.464 ± 0.11 vs. 0.44 ± 0.09, p = 0.349). Although tricuspid regurgitation was observed in 14 of 57 fetuses (24.6%) exposed to indomethacin, perinatal outcomes were not significantly different.

Conclusions: Indomethacin treatment does not negatively affect fetal cardiac function or Mod-MPI. When tricuspid regurgitation occurs, increased monitoring is recommended rather than treatment cessation if other parameters remain stable.

Background: To evaluate whether tranexamic acid (TXA) administration reduces the prevalence of severe postpartum hemorrhage (sPPH), defined as a hemoglobin drop of ≥ 3 g/dL, in primiparous women undergoing vacuum-assisted vaginal delivery (VAVD).

Methods: A retrospective cohort study was conducted at a large tertiary medical center, including all primiparous women undergoing VAVD between January 2021 and December 2022. TXA (1 g IV within 30 min of delivery) was administered at the discretion of the attending clinician, such that some women received TXA while others did not. The primary outcome was sPPH. Secondary outcomes included postpartum transfusion of blood products, absolute decline in hemoglobin levels, and additional clinical interventions related to hemorrhage, such as manual removal of the placenta or administration of uterotonic agents for the treatment of uterine atony. Initial comparisons were performed between TXA-treated and untreated women in the overall cohort. To account for baseline differences in the likelihood of receiving TXA, propensity score matching was performed using relevant clinical predictors; neonatal birthweight, prolonged second or third stage of labor, manual uterine revision. Logistic regression models were used for adjusted analyses.

Results: During the study period, 6,580 primiparous women delivered, of whom 1,048 (15.9%) met the inclusion criteria and comprised the study cohort (N = 1,048). Of these, 383 (36.5%) received TXA, and 274 (26.1%) experienced sPPH. TXA-treated women had higher sPPH rates compared to untreated women (33.5% vs. 22.1%, p < 0.001), greater mean hemoglobin drop (2.54 ± 1.3 vs. 2.18 ± 1.3 g/dL, p < 0.001), and increased postpartum blood transfusion rates (3.7% vs. 1.5%, p = 0.031). Propensity score matching (367 pairs) yielded similar results, with sPPH remaining more prevalent in the TXA group (31.7% vs. 18.8%, p < 0.001).

Conclusions: Primiparous women undergoing VAVD are at increased risk for sPPH. Administration of 1 gram of TXA within 30 min of delivery was not associated with a reduction in the prevalence of sPPH or the need for postpartum blood transfusion. Given the non-randomized design and retrospective nature of the study, it was not possible to determine whether TXA was administered prophylactically or in response to active bleeding. Nevertheless, TXA did not appear to reduce the prevalence of sPPH. Further research is needed to identify effective interventions for sPPH prevention in this high-risk population.